Week 6

Question 1

Positioning

Answer 1

• Can be used for decreased joint range, contracture, malformation, muscle stiffness - positioning
• Used in plagiocephaly/brachycephaly
• Cranial orthosis - more effective outcome than positioning
• bedding pillows and stretching exercises both improve positional cranial deformation

Question 2

Stretching, passive and active movements

Answer 2

• For decreased joint range, contracture, malformation, muscle stiffness
• Passive and active movements = torticollis, brachial plexus lesions, foot anomalies
• Active assisted movements more effective than passive in torticollis
• Whilst passive and active stretching is usually performed to address abnormally short musculoskeletal-tendinous units, stretching increases ROM by reducing musculo-tendon stiffness but the effect only lasts a short time
• Only long term stretching (>6 hrs) leads to increase in sarcomere numbers

Passive movements (4/10), no effect in stretching for torticollis (6/10),

Question 3

Casting, splinting and orthoses

Answer 3

• Can help with decreased joint range, contracture, malformation, muscle stiffness
• Developmental hip dysplasia, foot anomalies, idiopathic toe walking, arthrogryposis, juvenile arthritis
• pavlik harness - restricts hip extension and add and allows hip to be maintained in flex and abd (90-95% success)

Decision to brace/apply orthoses:
1. Prevention of deformity
2. Correction of deformity
3. Promotion of stable base of support
4. Facilitate development of skills
5. Improve efficiency of gait

Review supporting casting for idiopathic toe-walkers

Question 4

Strengthening/active exercises

Answer 4

• Intervention for muscle weakness/wasting
• General consensus that active exercises is preferable to passive or static movement
• Limited evidence for resistance training to improve strength
• Good evidence to support aerobic training in children with osteogenesis imperfecta (8/10)
• Both water based and land based physiotherapy had positive implications on children with juvenile idiopathic arthritis (8/10)
• Weight based exercise program to improve muscle strength is recommended for children and adolescents with JIA (5/10)